Reconstruction of large maxillary defect with the use of vastus lateralis (VL) free
flap. Case report
Nikolaos PAPADOGEORGAKIS, Vlasios OKTSELOGLOU, Eleni PAPPA, Petros SPYRIOUNIS
University clinic of Oral & Maxillofacial Surgery Clinic. «Evangelismos», General Hospital, Athens, Greece (Head: Professor C. Αlexandridis)
Hellenic Archives of Oral & Maxillofacial Surgery (2010) 2, 83-90
SUMMARY: Large defects of the maxilla, following abla tive surgery, significantly affect functions such as chewing, swallowing, speech and also the aesthetics. Reconstruction of soft tissues and bone defects can be achieved, either with the use of an obturator, or with free flaps. In the literature there is no sufficient evidence on the primacy of the one or the other method. The choice depends on the judgment, the experience and the ability of the surgical team. In recent years, the use of anterolateral thigh (ALT) free flap for reconstruction of large defects of the maxillary region, has gained a lot of popularity. The vastus lateralis free flap (VL) is a variation of ALT. VL’s advantages include long pedicle, easier harvesting, and fewer anatomical variations. We present a case of a 75 year old male with recurrent squamous cell carcinoma of the medial canthal region, invading the maxillary bone, the medial wall and the floor of the orbit. The patient underwent a total maxillectomy, orbital exenteration, and reconstruction with vastus lateralis free flap.
KEY WORDS: Μaxillary defects, free flaps, vastus late - ralis
REFERENCES
Blackwell K.E, Buchbinder D, Biller HF, Urken ML: Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps, Head Neck 19:620–628, 1997
Brown JS, Rogers SN, McNally DN, Boyle M: A modified classification for the maxillectomy defect. Head Neck 22:17-26, 2000
Gellrich NC, Kwon TG, Lauer G, Fakler O, Gutwald R, Otten JE et al: The lateral upper arm free flap for intraoral reconstruction. Int J Oral Maxillofac Surg 29:104–111, 2000
Hester TR, McConnel FMS, Nahail F, Jurkiewicz MJ, Brown RG: Reconstruction of cervical esophagus, hypopharynx and oral cavity using free jejunal transfer, Am J Surg 140:487–491, 1980
Kimata Y, Uchiyama K, Ebihara S, Yoshizumi Y, Asai M, Saikawa M et al: Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects, Arch Otolaryngol Head Neck Surg 123:1325–1331, 1997
Martis Ch, Papadogeorgakis N, Marti Κ: The temporalis muscle flap in the reconstruction of maxillary surgical defects. Greek J Oral Maxillofacial Surg 2:1-6, 1987
Minami RT, Hentz VR, Vistnes LM: Use of vastus lateralis muscle flap for repair of trochanteric pressure sores. Plast Reconstr Surg 60:364–368, 1977
Mureau MAM, Posch ASN, Meeuwis GA, Hofer SO: Anterolateral thigh flap reconstruction of large external facial skin defects: a follow up study on functional and aesthetic recipient and donor site outcome. Plast Reconstr Surg 115:1077–1086, 2005
Nakatsuka T, Harii K, Yamada A, Asato H, Ebihara S: Versatility of a free inferior rectus abdominis flap for head and neck reconstruction: analysis of 200 cases. Plast Reconstr Surg 93:763–769, 1994
Nelson JA, Serletti JM, Wu LC: The vastus lateralis muscle flap in head and neck reconstruction: an alternative flap for soft tissue defects. Ann Plast Surg 64(1):28-30, 2010
Schipper J, Boedeker CC, Horch RE, Ridder GJ, Maier W: The free vastus lateralis flap for reconstruction in ablative oncologic head and neck surgery. Eur J Surg Oncol 32(1):103-7, 2006
Schusterman MA, Horndeski G: Analysis of the morbidity associated with immediate microvascular reconstruction in head and neck cancer patients. Head Neck 13:51–55, 1991
Shaw RJ, Batstone MD, Blackburn TK, Brown JS: The anterolateral thigh flap in head and neck reconstruction: "pearls and pitfalls". Br J Oral Maxillofac Surg 48(1):5-10, 2010
Soutar DS, Scheker LR, Tanner NSB, McGregor IA: The radial forearm flap: a versatile method for intraoral reconstruction. Br J Plast Surg 36:1–8, 1983 Spyriounis PK, Lutz SB: Versatility of the Free Vastus Lateralis Muscle Flap. J Trauma 64:1-7, 2008
Spyriounis PK: The extended approach to the vascular pedicle of the anterolateral thigh perforator flap: anatomical and clinical study. Plast Reconstr Surg 117(3):997-1001, 2006
Swartz WM, Ramasastry SS, McGill JR, Noonan JD: Distally based vastus lateralis muscle flap for coverage of wounds about the knee. Plast Reconstr Surg 80:255–265, 1987
Tsai CY, Wei FC, Chang YL, Chen YY, Chen CT: Vastus lateralis muscle flap used for reconstruction of the maxilla after radical resection of recurrent ameloblastoma. Chang Gung Med J 29:331–335, 2006
Valentini V, Cassoni A, Marianetti TM, Battisti A, Terenzi V, Iannetti G: Anterolateral thigh flap for the reconstruction of head and neck defects: alternative or replacement of the radial forearm flap? J Craniofac Surg 19(4):1148-53, 2008
Wang Y, Beguet T, Masquelet AC: Anatomic study of the distally based vastus lateralis muscle flap. Plast Reconstr Surg 103: 101–103, 1999
Wolff KD: Indications for the vastus lateralis flap in oral and maxillofacial surgery. Br J Oral Maxillofac Surg 36:358 –364, 1998
University clinic of Oral & Maxillofacial Surgery Clinic. «Evangelismos», General Hospital, Athens, Greece (Head: Professor C. Αlexandridis)
Hellenic Archives of Oral & Maxillofacial Surgery (2010) 2, 83-90
SUMMARY: Large defects of the maxilla, following abla tive surgery, significantly affect functions such as chewing, swallowing, speech and also the aesthetics. Reconstruction of soft tissues and bone defects can be achieved, either with the use of an obturator, or with free flaps. In the literature there is no sufficient evidence on the primacy of the one or the other method. The choice depends on the judgment, the experience and the ability of the surgical team. In recent years, the use of anterolateral thigh (ALT) free flap for reconstruction of large defects of the maxillary region, has gained a lot of popularity. The vastus lateralis free flap (VL) is a variation of ALT. VL’s advantages include long pedicle, easier harvesting, and fewer anatomical variations. We present a case of a 75 year old male with recurrent squamous cell carcinoma of the medial canthal region, invading the maxillary bone, the medial wall and the floor of the orbit. The patient underwent a total maxillectomy, orbital exenteration, and reconstruction with vastus lateralis free flap.
KEY WORDS: Μaxillary defects, free flaps, vastus late - ralis
REFERENCES
Blackwell K.E, Buchbinder D, Biller HF, Urken ML: Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps, Head Neck 19:620–628, 1997
Brown JS, Rogers SN, McNally DN, Boyle M: A modified classification for the maxillectomy defect. Head Neck 22:17-26, 2000
Gellrich NC, Kwon TG, Lauer G, Fakler O, Gutwald R, Otten JE et al: The lateral upper arm free flap for intraoral reconstruction. Int J Oral Maxillofac Surg 29:104–111, 2000
Hester TR, McConnel FMS, Nahail F, Jurkiewicz MJ, Brown RG: Reconstruction of cervical esophagus, hypopharynx and oral cavity using free jejunal transfer, Am J Surg 140:487–491, 1980
Kimata Y, Uchiyama K, Ebihara S, Yoshizumi Y, Asai M, Saikawa M et al: Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects, Arch Otolaryngol Head Neck Surg 123:1325–1331, 1997
Martis Ch, Papadogeorgakis N, Marti Κ: The temporalis muscle flap in the reconstruction of maxillary surgical defects. Greek J Oral Maxillofacial Surg 2:1-6, 1987
Minami RT, Hentz VR, Vistnes LM: Use of vastus lateralis muscle flap for repair of trochanteric pressure sores. Plast Reconstr Surg 60:364–368, 1977
Mureau MAM, Posch ASN, Meeuwis GA, Hofer SO: Anterolateral thigh flap reconstruction of large external facial skin defects: a follow up study on functional and aesthetic recipient and donor site outcome. Plast Reconstr Surg 115:1077–1086, 2005
Nakatsuka T, Harii K, Yamada A, Asato H, Ebihara S: Versatility of a free inferior rectus abdominis flap for head and neck reconstruction: analysis of 200 cases. Plast Reconstr Surg 93:763–769, 1994
Nelson JA, Serletti JM, Wu LC: The vastus lateralis muscle flap in head and neck reconstruction: an alternative flap for soft tissue defects. Ann Plast Surg 64(1):28-30, 2010
Schipper J, Boedeker CC, Horch RE, Ridder GJ, Maier W: The free vastus lateralis flap for reconstruction in ablative oncologic head and neck surgery. Eur J Surg Oncol 32(1):103-7, 2006
Schusterman MA, Horndeski G: Analysis of the morbidity associated with immediate microvascular reconstruction in head and neck cancer patients. Head Neck 13:51–55, 1991
Shaw RJ, Batstone MD, Blackburn TK, Brown JS: The anterolateral thigh flap in head and neck reconstruction: "pearls and pitfalls". Br J Oral Maxillofac Surg 48(1):5-10, 2010
Soutar DS, Scheker LR, Tanner NSB, McGregor IA: The radial forearm flap: a versatile method for intraoral reconstruction. Br J Plast Surg 36:1–8, 1983 Spyriounis PK, Lutz SB: Versatility of the Free Vastus Lateralis Muscle Flap. J Trauma 64:1-7, 2008
Spyriounis PK: The extended approach to the vascular pedicle of the anterolateral thigh perforator flap: anatomical and clinical study. Plast Reconstr Surg 117(3):997-1001, 2006
Swartz WM, Ramasastry SS, McGill JR, Noonan JD: Distally based vastus lateralis muscle flap for coverage of wounds about the knee. Plast Reconstr Surg 80:255–265, 1987
Tsai CY, Wei FC, Chang YL, Chen YY, Chen CT: Vastus lateralis muscle flap used for reconstruction of the maxilla after radical resection of recurrent ameloblastoma. Chang Gung Med J 29:331–335, 2006
Valentini V, Cassoni A, Marianetti TM, Battisti A, Terenzi V, Iannetti G: Anterolateral thigh flap for the reconstruction of head and neck defects: alternative or replacement of the radial forearm flap? J Craniofac Surg 19(4):1148-53, 2008
Wang Y, Beguet T, Masquelet AC: Anatomic study of the distally based vastus lateralis muscle flap. Plast Reconstr Surg 103: 101–103, 1999
Wolff KD: Indications for the vastus lateralis flap in oral and maxillofacial surgery. Br J Oral Maxillofac Surg 36:358 –364, 1998
How to cite this article:
|
View the full-text PDF:
|
| ||